Surveillance of Mycobacterium tuberculosis susceptibility to second-line drugs in Hong Kong, 1995–2002, after the implementation of DOTS-Plus
Abstract:OBJECTIVE: To determine the trend in changes in susceptibility of Mycobacterium tuberculosis strains, including to second-line drugs, from patients with a history of previous anti-tuberculosis (TB) treatment in a ‘DOTS-Plus’ programme.
METHODS: A retrospective survey of centralised M. tuberculosis laboratory records of all culture-positive cases over an 8-year period. The drug susceptibility of the isolates was determined using the absolute concentration method. Isolates obtained from patients with a history of previous treatment were further analysed for trends of changes in susceptibility to first- and second-line drugs.
RESULTS: Of 1921 patients with a previous history of treatment and positive cultures, 1425 (74.2%) had isolates susceptible to all four first-line drugs, while 176 (9.2%) were multidrug-resistant (MDR-TB). For the MDR-TB group, 101 (57.4%) isolates were sensitive to all second-line drugs, while 30 (17.0%) were resistant to three or more second-line drugs.
CONCLUSION: In a DOTS-Plus programme environment where there is strict control on use of second-line drugs, the prevalence of MDR-TB is low amongst re-treatment cases and the prudent use of second-line drugs in a population with well functioning DOTS-Plus programme does not generate super-resistant strains. In circumstances where most retreatment strains are still susceptible and good laboratory support for detection of MDR cases is available, retreatment using first-line drugs is feasible.
Document Type: Regular Paper
Affiliations: Public Health Laboratory Centre, Tuberculosis Reference Laboratory, Kowloon, Hong Kong SAR, China
Publication date: 2004-06-01
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